Team Deliberate Practice in Nursing Undergraduate Simulation-based Education

Platt, Alan (2019) Team Deliberate Practice in Nursing Undergraduate Simulation-based Education. Doctoral thesis, Northumbria University.

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Abstract

The use of simulation-based education as a learning and teaching methodology has grown in prominence over the past decade in the education and training of healthcare professionals. Despite this and, a growing evidence base for its use, a wide variation in the quality of its provision has been reported. In addition, this methodology, due to the resource intensive nature of its delivery, has significant costs attached to it, which has led to increasing calls to justify its continued use. As a result, simulation-based education should be underpinned by high quality pedagogic research that was aimed at identifying the instructional design features that both augmented its delivery and enriched participant learning.

This thesis was undertaken to develop a new simulation-based education approach that would enhance the learning of student nurses within the finite institutional resources available. A literature review identified that the deliberate practice framework and, in particular, team deliberate practice, offered a possible solution to this problem. This led me to develop the Simulation using Team Deliberate Practice model. A unique and innovative model that combined both simulation-based education standards with the deliberate practice framework. This offered participants the opportunity to work towards a set of well-defined goals, rehearse their skills in a highly structured model that empowered them to review and reflect on their performance whilst receiving expert guidance and feedback.

Using a longitudinal quasi-experimental design, the effects of the Simulation using Team Deliberate Practice model, compared to those of the traditional simulation-based education method, on the performance, knowledge and self-efficacy of second year adult nursing students. Performance was measured at a sub-group level using the participants established study groups (N=4), which were randomised into either the intervention (N=2) or comparison (N=2) arms of the study. These were further divided into four sub-groups each giving sixteen sub-groups in total (Intervention arm n=8 and comparison arm n=8). The knowledge and self-efficacy of the participants (N=93) was measured at an individual level.

Data was analysed using a range of statistical techniques. The findings from the mixed ANOVA analysis inferred that the use of the Simulation using Team Deliberate Practice model led to a statistically significant improvement, over time, in the performance of participants (F(1, 6) = 19.12, p = .005), a key feature of deliberate practice. Statistically significant improvements in the interventions arms performance scores (t(7) = -7.02, p = <.001) and reduction in their time on task (t(14) = 5.12, p = <.001) in phase one were also found. Thus inferring an association between the Simulation using Team Deliberate Practice model and the enhanced performance of the participants in the intervention groups, which enabled them to achieve greater levels of performance over the same time period as those undertaking traditional simulation-based education. There were no statistically significant effects found on the knowledge and self-efficacy of the participants.

The study concluded that using the Simulation using Team Deliberate Practice model was a viable approach to use within adult nursing pre-registration education as it could potentially optimise participant’s performance whilst maximising the delivery of simulation-based education in the resources available. As professional nursing regulators and educational institutes explore replacing clinical practice with simulation this potentially would be of interest to simulation based educators in nursing. This approach could also be easily integrated into an existing programme and, as such, could positively impact on the delivery of simulation-based education in the area of pre-registration adult nursing.

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